HomeMy WebLinkAbout014-841-05-3104-LUP-2004-118 Application for Land Use Permit(*Non-shoreland*) o o �'
County of Sawyer �, � �
PO Box 676 -Haywazd WI 54843
715/634-8288 � -
*Property that is not located within 300'of a creek,river or stream or within 1000'of a (� �
flowage,lake or pond or does not have any of the above waterbodies located within Z
the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
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Owner Builder <' �
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Mailing Address e Mailing Address �
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City,State,Zip City,State,Zip
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Daytime Phone Daytime Phone �
Additional Information: Zone District: ��"�� � � Q
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Lot Dimensions: �`
Date lot was created: � � �' �'��'' Acres �� : � o �,,�
Is there wetland near the proposed structure?If yes,how faz �
Building Land Use Floodptain:O Yes O No `; ��
�,�Vew ( )Filling � ��
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O Addition O Dredging Driveway access off of a(Check one): � �,
O Alteration O Grading �Q Private Rd O Town Rd. o �
�Moving On O O County Hwy O State Hwy N �
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Primary Structure Accessory Building Addition � °
Qg,Dwelling O Garage-attached/detached O Deck W Cn
(y�,Yeaz round ( )#of car stalls ( )Porch = �
( )Seasonal ( )Storage Building ( )Enclosed `D
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( )Frame built on site ( )Screenhouse ( )Living room Z
�„Modulaz/manufactured ( )Greenhouse ( )Kitchen � 1�2
( )Mobile/manufactured ( )Other ( )Bedroom A
( )Other primazy structure ( ) ( )Relocate/enlarge �
� � ( ) ( )#of new �
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Additional Information: �<�,G��.,j e X�s�"'{ ���"'z ' ;
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Type of Construction: � p
�rame ( )Log ( )Pole/metal ( )Block ( )Concrete p (�+
( )Other ,,d �
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Construction Cost:Primary Structure$ ...� G�.y J{j<j �
Accessory Building:$ Addition:$ � 1..2�
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Dee d:Vo l ]� �, Pg .��n Ce rti f i e d S o i l T e s t# `�'S/-/�5 °O Z
CSM:Vol a a pg /y Lot#�_ Sanitary Permit# `��f- I`'7/ ���7 0, %ro
Plat Envelope � �°��8 Or: �, �'`�j
� I�Condo Vol Pg Year Installed: �c
Aff of ex septie Vol Pg Owner When Installed: `-' �
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Previous office approvals/actions: -
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Variance:# LUP:# SP:# CUP:#
a
Inspection Report:# Change of Zone District: L
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I(��35
Describe the construction using these columns. List the dimensions of each structure in a separate .
column. List each story, each addition, each alteration in a separate column.
#1. 1 i, � #2. �t�,4 �: , . , ,, ,��` #3. #4.
Size r� ;; ft. wide ? 't ft. wide ft. wide ft. wide
�;j fr. long :3 i} ft. long ft. long ft. long
Floor area �'y�'x`� sq. ft. /`/�(S sq. ft. sq. fr. sq. ft.
Hgt.from grade 1(�to ft. hgt. /Ff fr. hgt. fr. hgt.
Stories ' �_stories stories stories
# of bedrooms
Rear Lot Line / �
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Fire Number and Name of Road rj }� {t�rr' i � >`"��t ��� � » ` t• `�`'
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction
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activities. �( � ' ,-
PnntName: � t" `� :'� � .".
3. Also, indicate the location and distance to the well, The above certifles that the listed Informa6'oryp intentlons are
hue and conect.,that all work shall be ped6rtned in compliance
septiC t3T11C and d7alnfle�d, wetland 3ieas, lot 11nes and to the with the requirements of ihe Sawyer Counry Zoning ordinance
and ihe laws and regulalions of the State of Wisconsin, and if
C0rit8i�lriC Of tI1C i08d. ading as owner(s)agent has the permission of the owner(s)to
perform the work requested on this application. The above
personsls hereby give permission for aoxss to ihe property for
� onsite inspectian.
Permit fee: $ �_ �'�J
May 4, 2004 C,LJ�M.1 AA'> l',�U'Q-U -� �`�'
Issue Date Signature ofI in gent � Q
May 4, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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SHOWN AS 66� 1MD1H FOFt
MAPPING PURPOSES.
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SAIIYER COUNTY CERTII��D SURVEY �[AP N0.
I.ocated m the South 1/2 of the NE 1/9 of the SW 1/4 of Sectlon 5,T.41 N,R B W,tn the
Town of I.enroot,Sewyer County.Wt�consln.
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��YVYER COUNTY CERTIF'IE1D SURVEY 3dAP N0.
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